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APPL�CATI�..�I FOR CONSTRUC7 .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> i 1 DEMOUTION f l COMBINATION I l BUILDING I I MECHANICAL i l PLUMBING fl SIGN <br /> PROJECT ADDRESS j/ /J � <br /> v/,'/i� 11'/�l �r 2 / <br /> OWNEti Mminonness cin nr riwr+e <br /> ��,G�., ���i���.s i��c�P�,:l�� x�FK(t a:s.z�s��9n _ <br /> IENANi IAAILAODRF55 CITY ZII' PIIONE <br /> ARCHIT[CTOROESIGNEp MAILADDRE CITY ZIP PHO4E <br /> GENERALCONTMCTOR M AD�RESS CItY ZIP // W�Jp d(� STRTELIGENSE• <br /> � � (.(JO �.�4 KFOUQ/�6�GPP <br /> �' nG N �.�'rw(cY.�r� �A'�l.�i.l..r /b/0!k��.r.�c•.d y Su <br /> MECHANICALCONTPACTOR MAILA�DRE55 Cltt 21P PIIONG STATEUCENSE� <br /> PLUMBINGCONTRnC10R MAILA�DRESS CItY ZIP pHONE STRIEUCENSE� <br /> CONTpRCT PpICE OF WOBK <br /> (g;��— HEATING SYSTEM: ❑GAS ❑ ELECTRIC p� <br /> DESCHIB WOPKA�U�FOOTAGE�NVOLVED GONTACTP�RSONANOPIIONENO. <br /> l �i <br /> �I � <br /> I HEREBY CERTIFV THAT I HAVE RE4D AND EXAMINED THIS <br /> PRO{'OSEO USE Of BUILDING APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCRIPTIONOFPROPERTY�SNOWNBEIOWDRRTfACMTWOC/OPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> 3y; 0C(dp ,(7.✓:Sio < AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> �oi a s D BLOCK OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAflCELiA%I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> � �0 � �[7 <br /> GONSiFUCTON LORN LENDEA,nDORE55.TS�EPNONE NUMBER x(��y�.:){. � ���_ <br /> SIGNNTURE OATE <br /> Cltt BUSINE55 LICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FUCTURE OR ITEM FEE N0. TYPE OF FIXTURE OR ITEM FEE <br /> WATERCLOSET(TOILET) - � A/C—A/HNDLGUNITS—H.P. � <br /> BATHTUB - ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATJRI'(WASH BASIN) - � HEAT PUMP � <br /> SHOWER � UNITHEATERS--B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS — i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY � RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS i GASPIREPLACE i <br /> cINK(SERVICE—BAR,ETC.) . � GAS RANGE � <br /> ' GAS PIPING ' <br /> i EXHAUSTFAN i <br /> � i <br /> SUB TOTAL 5 " "� ; SUB TOTAL $ ; <br /> PERMIT 5 � PERMIT 5 � <br /> TOTALPEE S � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: �1= ���" � � Q/ � G <br /> FRONT SET—BAOG� REAq SETBACK ' SIDE SEiOnC' PLAN C11 CN N IM A FEE� � 00 E�P7 NO/ <br /> J / <br /> use zo � iot nnen � vneaNr sie FEES VALUATION FEE <br /> � J�Q�I'�p : nves rvo euaoirvc q 36 �2�7 � <br /> HEIGHTLIMIiATION NO.OFDWEWNG SIZEOF9L�GRI i . <br /> uruits � -79Z Sf /-IOON rwn+oir+c rl <br /> OCCUPANCV NOOFSTORIES OGCUPANiLOAD BASEMENi M[CMANICAI �O i <br /> r, ou <br /> , 2- (�l nres o � <br /> fIREALARMREOD REASON ADDIPONALPLANCNECK _j_ <br /> T <br /> OTNER � <br /> —}— <br /> FIRE SPPINRLER REOD REASON � <br /> STAIE DUILDING SURCMARGE i � <br /> LVf�EOFCONSi vinNsnrrno�epav C�TYOFEVERETT ruaucwonKs —�' <br /> `��" LOCALSALES .� —7� � <br /> --h/ o4rE (� iZ �j7 'fAX CODE IS 3105 TOTAL �)'� / �, <br />